Journal of endourology最新文献

{"title":"Optimization of Cone Beam Computed Tomography Scan Protocols for the Intraoperative Detection of Residual Stones in Percutaneous Nephrolithotomy.","authors":"Riemer Adam Kingma, Nienke T L van Asten, Marcel J W Greuter, Igle J de Jong, Stijn Roemeling","doi":"10.1089/end.2024.0732","DOIUrl":"10.1089/end.2024.0732","url":null,"abstract":"<p><p><b><i>Purpose:</i></b> The primary surgical treatment modality for large or complex renal stones is percutaneous nephrolithotomy (PCNL). Cone beam computed tomography (CBCT) allows for intraoperative imaging and can be used to enhance intraoperative assessment of a stone-free status during a PCNL procedure. However, scanning protocols have not yet been optimized for this purpose. The high degree of stone and patient characteristics require a tailored approach. This study aimed to select the most suitable CBCT protocols for imaging stone fragments intraoperatively during PCNL. <b><i>Methods:</i></b> A phantom insert with 100 calcifications varying in size and density was placed in an anthropomorphic abdominal phantom. Nine different CBCT protocols were used with varying dose and copper filter settings, and each scan was repeated five times with a small translation between each scan. Detectability of the calcifications was scored by visual assessment and visibility curves were generated for each protocol, depicting the minimum size and density at which calcifications were still detectable. Image noise and contrast-to-noise ratios (CNRs) were calculated for each protocol, as well as estimated effective patient doses per CBCT scan. <b><i>Results:</i></b> Calcification detectability and CNRs decreased with a decrease in radiation dose, whereas noise ratios increased. Three suitable scanning protocols were selected, a high-dose or soft-stone CBCT protocol resulting in an effective dose of 10.7 millisievert (mSv) per CBCT scan, a medium-dose CBCT protocol resulting in an effective dose of 4.6 mSv and a low-dose or hard-stone CBCT protocol resulting in an effective dose of 2.2 mSv. <b><i>Conclusion:</i></b> Radiation dose for intraoperative CBCT for imaging calcifications can effectively be lowered while maintaining calcification visibility, by implementing low-dose CT protocols with lowered dose settings and the application of a copper filter. The three proposed scanning protocols provide options to select a scan protocol based on stone type and patient characteristics.</p>","PeriodicalId":15723,"journal":{"name":"Journal of endourology","volume":" ","pages":"509-516"},"PeriodicalIF":2.9,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143572344","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Robot-Assisted Laparoscopic Pyeloplasty in Infants Under 3 Months: Single-Institution Study Findings, Safety Measures, and Success Strategies.","authors":"Wei Li, Xinjin She, Chao Chen, Bo Shi, Peng Chen, Jingchu Luo, Zuxin Yuan, Weichao Li, Hai Zhu, Yige Luo","doi":"10.1089/end.2024.0717","DOIUrl":"10.1089/end.2024.0717","url":null,"abstract":"<p><p><b><i>Background:</i></b> At present, there is a lack of cohort studies on robot-assisted laparoscopic pyeloplasty (RALP) for the treatment of ureteropelvic junction obstruction (UPJO) in infants under 3 months of age. This study aims to enhance the understanding of the safety and efficacy of RALP in this specific infant population. <b><i>Methods:</i></b> We retrospectively analyzed the clinical data of children with UPJO who underwent unilateral pyeloplasty at our center from January 2019 to June 2022. We categorized the children based on their ages: those younger than 3 months old comprised the RA group (25 cases), whereas those aged 3 months to 3 years old formed the RB group (25 cases). We collected and statistically analyzed the baseline data, perioperative details, postoperative complications, and the recovery of split renal function (SRF) along with the improvement in hydronephrosis for both patient groups. <b><i>Result:</i></b> Both age groups successfully underwent the operation without requiring conversion to open surgery. There were no significant differences observed in the operation time or postoperative hospitalization duration between the two groups (<i>P</i> > 0.05). Following surgery, both groups showed significant improvements in anteroposterior diameter (APD) and SRF (<i>P</i> < 0.05). However, there was no significant discrepancy noted in the recovery of APD and SRF between the two groups postoperatively (<i>P</i> > 0.05). Additionally, there were no significant variations in postoperative complications between the two groups (<i>P</i> > 0.05). <b><i>Conclusion:</i></b> Given the mature and stable nature of the surgical technique, RALP proves effective in treating UPJO in infants younger than 3 months, yielding favorable therapeutic outcomes.</p>","PeriodicalId":15723,"journal":{"name":"Journal of endourology","volume":" ","pages":"470-476"},"PeriodicalIF":2.9,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143670036","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Risk Factors for Conversion to Open Surgery in Laparoscopic Nephrectomy for Xanthogranulomatous Pyelonephritis: A Multicenter Study.","authors":"José Iván Robles-Torres, José Antonio Zapata-González, Marcos Andrés Sánchez-Rendón, Fred Alain Montelongo-Rodríguez, Jesús García-Saucedo, Santosh Kumar, Bhaskar K Somani, Vineet Gauhar, Adrián Gutiérrez-González","doi":"10.1089/end.2024.0814","DOIUrl":"10.1089/end.2024.0814","url":null,"abstract":"<p><p><b><i>Introduction and Objective:</i></b> Xanthogranulomatous pyelonephritis (XGP) is an infrequent, but life-threatening, chronic granulomatous pyelonephritis. Surgical intervention can be challenging because of severe inflammation and often a fibrotic reaction that obliterates anatomical landmarks. In addition, a high rate of open conversion has been reported when performing a laparoscopic nephrectomy. The aim of this study is to determine the risk factors for open conversion in patients with histologically confirmed XGP who underwent laparoscopic nephrectomy. <b><i>Methods:</i></b> A multicenter retrospective study was performed, including patients who underwent laparoscopic nephrectomy between 2018 and 2022 with histopathologic diagnosis of XGP. Clinical and laboratory parameters at initial presentation were evaluated. Extension of XGP was recorded as per the Malek clinical-radiological classification. Characteristics of laparoscopic nephrectomy and perioperative outcomes were obtained. The primary outcome was conversion to open surgery. Secondary outcomes included major complications, evaluated by Clavien-Dindo ≥3, and organ injuries during the procedure. <b><i>Results:</i></b> A total of 49 patients from 5 centers were included, with a mean age of 46.5 ± 17.7 years. Conversion to open surgery was reported in 10 cases (20.4%). Major complications were reported in 13 cases (26.5%), and organ injuries were reported in 10 patients (20.4%). Colonic (3 cases, 6.1%) and pleura injuries (3 cases, 6.1%) were the most frequently affected organ. The presence of renal abscess (odds ratio [OR]: 3.174, <i>p</i> = 0.003) and paranephric extension of disease (Malek stage 3) (OR: 14, <i>p</i> = 0.016) were independent factors related to conversion to open surgery. <b><i>Conclusion:</i></b> Laparoscopic nephrectomy for XGP is a technically challenging procedure because of extensive chronic inflammation and fibrosis. The presence of renal abscess and Malek stage III are independent predictors of conversion to open. Despite these challenges, laparoscopic nephrectomy remains a viable and effective approach for managing XGP, with the potential for reduced recovery time and postoperative morbidity compared with open surgery.</p>","PeriodicalId":15723,"journal":{"name":"Journal of endourology","volume":" ","pages":"464-469"},"PeriodicalIF":2.9,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143597130","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Surgical Gesture Utilization and Efficacy Trends Between Retractions in Surgeons Performing the Robot-Assisted Nerve-Sparing Prostatectomy.","authors":"Umar Ghaffar, John Heard, Runzhuo Ma, Cherine Yang, Jonathan Varghese, Randy G Tsai, Peter Wager, Eman Dadashian, Christian Wagner, Graciela Gonzalez-Hernandez, Andrew J Hung","doi":"10.1089/end.2024.0572","DOIUrl":"10.1089/end.2024.0572","url":null,"abstract":"<p><p><b><i>Objective:</i></b> Surgical gestures, defined as the smallest meaningful interactions of surgical instruments with tissue, are a novel approach to objectively deconstruct surgery. We have previously classified gestures among three major categories: blunt, sharp, and supporting. Retraction is a supporting gesture, which involves placing tissue on stretch to gain better access to surgical site and to allow tension for effective tissue dissection. We aim to assess utilization and efficacy trends of gestures between these retractions, based on surgeon experience and the anatomical location where gestures are performed. <b><i>Methods:</i></b> Robotic prostatectomy surgical videos from two centers were captured and manually annotated to identify each surgical gesture, its efficacy and anatomical location, using a classification system previously published. Surgeons were separated by median split-high experience (HE) <i>vs</i> low experience (HE). Sequences of gestures within each sequential retraction gesture were labeled as retraction units (RUs). RUs were split equally into quartiles based on number of gestures in that RU and trends in gesture efficacy were described. <b><i>Results:</i></b> Overall, 61 surgical videos were annotated to identify 21,045 gestures. Median gestures per case were 222 (interquartile range [IQR]: 163-364) and 337 (IQR: 222-398) for surgeons with HE and LE, respectively. HE surgeons had fewer RUs (<i>p</i> < 0.001), higher gestures per RU (<i>p</i> = 0.031) and greater gesture efficacy (<i>p</i> = 0.023) per RU. There was a significant decline in gesture efficacy for blunt gestures as evaluated from first to last quartile within each RU (<i>p</i> < 0.001). This decline was evident for both HE (<i>p</i> < 0.001) and LE surgeons (<i>p</i> = 0.009) and irrespective of the anatomical location (pedicle, <i>p</i> = 0.04; lateral fascia, <i>p</i> = 0.01). <b><i>Conclusion:</i></b> Experienced surgeons demonstrated higher gesture efficacy, fewer retractions, and more gestures per RU. Decline in gesture efficacy for blunt gestures is apparent across each RU irrespective of surgeon experience and anatomical location, suggesting re-retract during dissection is an active and dynamic activity.</p>","PeriodicalId":15723,"journal":{"name":"Journal of endourology","volume":" ","pages":"457-463"},"PeriodicalIF":2.9,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143772526","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Precision in Access: The Laser Direct Alignment Radiation Reduction Technique <i>Versus</i> Conventional Fluoroscopic Renal Access.","authors":"Zhamshid Okhunov, Alphie Rotinsulu, Ala'a Farkouh, Rose Leu, Grant Sajdak, Matthew Buell, Akin S Amasyali, Kanha Shete, Vance Gentry, Udochukwu Oyoyo, David S Benjamin, D Duane Baldwin","doi":"10.1089/end.2024.0802","DOIUrl":"10.1089/end.2024.0802","url":null,"abstract":"<p><p><b><i>Introduction and Objective:</i></b> The laser direct alignment radiation reduction technique (DARRT) presents a novel approach integrating pulsed low-dose fluoroscopy, ultrasound, direct endoscopic visualization, and laser targeting to minimize fluoroscopy exposure during percutaneous nephrolithotomy (PCNL). This study aims to evaluate the safety and efficacy of laser DARRT in comparison with traditional fluoroscopic PCNL access. <b><i>Methods:</i></b> A retrospective analysis was conducted on patients who underwent PCNL. Patients with pre-existing nephrostomy tubes for access and those who underwent solely ultrasound-guided access were excluded from the study. The primary outcomes of the study were comparing fluoroscopy time used for renal access and total fluoroscopy time between the two groups. Secondary outcomes included relative stone-free rates (SFR) defined as ≤4 mm fragments on postoperative computed tomography scan and complication rates. Continuous variables were compared using an independent-sample <i>t</i> test, whereas categorical variables were compared using the chi-square test, with significance set at <i>p</i> < 0.05. <b><i>Results:</i></b> A total of 292 patients were eligible for the study. The laser DARRT reduced both access fluoroscopy time (10.8 <i>vs</i> 551.7 seconds; <i>p</i> < 0.001) and total fluoroscopy time (21.8 <i>vs</i> 597.7 seconds; <i>p</i> < 0.001). The relative SFR was significantly higher in the laser DARRT group compared with the conventional group (84.1% <i>vs</i> 64.1%; <i>p</i> < 0.001). There was no significant difference in complication rates between the two groups (<i>p</i> > 0.05). <b><i>Conclusions:</i></b> The laser DARRT led to a >95% reduction in access and total fluoroscopy times. By combining the advantages of fluoroscopy, ultrasound, endoscopic vision, and laser guidance, this technique represents a promising option for improving outcomes and minimizing radiation-related risk.</p>","PeriodicalId":15723,"journal":{"name":"Journal of endourology","volume":" ","pages":"443-450"},"PeriodicalIF":2.9,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143803249","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Drivers of Cost Variability of Ureteroscopy with Laser Lithotripsy at an Academic Institution.","authors":"Tyler Bergeron, Ilir Agalliu, Alexander C Small, Dima Raskolnikov","doi":"10.1089/end.2024.0801","DOIUrl":"10.1089/end.2024.0801","url":null,"abstract":"<p><p><b><i>Objective:</i></b> Ureteroscopy with laser lithotripsy (URS/LL) requires significant disposable equipment including wires, baskets, lasers, and stents. Surgeons choose this equipment based on preference, with higher- and lower-cost options available. We sought to explore factors that affect cost variability among urologists performing URS/LL within a single academic medical center. <b><i>Patients and Methods:</i></b> We retrospectively reviewed all patients who underwent URS/LL at our institution between September 2022 and June 2023. A weighted cost for each item's contribution to total cost was generated. Bivariate and then multivariate median regression models were generated to identify variables associated with higher total surgical cost. Statistical significance was considered <i>p</i> < 0.05. <b><i>Results:</i></b> A total of 311 patients underwent URS/LL during the study period with 14 different surgeons. The total median cost of disposable equipment for the entire cohort was $1488/operation. On multivariate regression, basket cost above the cohort median or specialized catheter cost above the cohort median was associated with increased total surgical cost (<i>p</i> < 0.001). Fellowship training in endourology was associated with a decreased cost of $90.40 per case (<i>p</i> < 0.05). <b><i>Conclusions:</i></b> There is significant variability in the cost of ureteroscopy, even at a single institution where all surgeons have access to identical supplies. Attention to specific categories of equipment, which appear to be associated with higher total cost, as well as the potential differences in technique between surgeons with varied training, may help to identify opportunities for institutional cost savings.</p>","PeriodicalId":15723,"journal":{"name":"Journal of endourology","volume":" ","pages":"438-442"},"PeriodicalIF":2.9,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143657354","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of Measurement Methods for Stone Volume Estimation: An <i>In Vitro</i> Study.","authors":"Felipe Pauchard, Frederic Panthier, Catalina Espinoza, Nataly Vejar, Eugenio Ventimiglia, Olivier Traxer","doi":"10.1089/end.2024.0524","DOIUrl":"10.1089/end.2024.0524","url":null,"abstract":"<p><p><b><i>Introduction:</i></b> Urolithiasis guidelines still rely on the maximum stone diameter to propose treatment strategy, although this measure is known to have many pitfalls. Stone volume (SV) could represent a more accurate measurement, helping to plan the treatment or follow-up. Various methods to measure SV have been proposed. We aimed to compare different methods to estimate SV. <b><i>Methods:</i></b> Fifteen stones (human and artificial) were assessed. Real SV was measured using the water displacement method. Volume estimation included three diameter-based formulas (Ackerman, 4/3 Pi r³ and r³/2) and two 3D segmentation methods (Horos and Kidney Stone Calculator [KSC]). All measurements were done by a single operator. Spearman correlation test and comparative analyses were conducted between the real and the estimated SV. <b><i>Results:</i></b> Compared with real SVs, Ackerman and r³/2 formulas estimated volume accurately in 2/15 (13%) of stones each. No accurate measurement was reported using the sphere formula. KSC did estimate volume accurately in 4/15 (27%) stones compared with the reference SV; Horos did it in 7/15 (47%) stones. Both segmentation methods presented strong correlation coefficients (<i>r</i> = 0.9642 and 0.9659, <i>p</i> < 0.0001), while formula correlation was moderate (<i>r</i> = 0.7531, <i>p</i> < 0.0001). <b><i>Conclusion:</i></b> Formulas and segmentation methods for SV estimation resulted in divergent outcomes. Segmentation methods (Horos and KSC) presented higher accuracies in SV estimation, compared with real SV. Formulas were the least accurate.</p>","PeriodicalId":15723,"journal":{"name":"Journal of endourology","volume":" ","pages":"488-493"},"PeriodicalIF":2.9,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143605014","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Is Outpatient Totally Tubeless Standard Percutaneous Nephrolithotomy Safe and Efficacious?","authors":"Kavita Gupta, Nir Tomer, Christopher Connors, Susan Gong, Raymond Khargi, Blair Gallante, William M Atallah, Mantu Gupta","doi":"10.1089/end.2024.0441","DOIUrl":"10.1089/end.2024.0441","url":null,"abstract":"<p><p><b><i>Introduction and Objectives:</i></b> Percutaneous nephrolithotomy (PCNL) is the gold standard treatment for large, complex intrarenal stones. Tubeless PCNL (t-PCNL) where no nephrostomy tube is placed and totally tubeless PCNL (tt-PCNL) in selected patients have been well described. There has been no study to our knowledge discharging patients the same day totally tubeless. In this study, we describe our experience with tt-PCNL on a totally outpatient basis-with the patient going home with absolutely no tube, catheter, or stent, evaluating its safety and efficacy vis-à-vis a comparison with outpatient t-PCNL patients discharged with an indwelling stent. <b><i>Methods:</i></b> We prospectively collected data from 130 consecutive patients scheduled for outpatient PCNL from August 2023 to January 2024. Demographics, stone characteristics, and intraoperative data were compared. Outcomes included postoperative (post-op) pain, stone-free rate (SFR), 30-day complications, and ED visits or readmissions. Categorical variables were compared using Chi-square or Fisher's exact tests and continuous variables via Mann-Whitney U tests. <b><i>Results:</i></b> After exclusions, 53 patients underwent tt-PCNL and 50 had t-PCNL. Demographics and stone burden did not differ between groups. No visceral or pleural injuries occurred in either group. Post-op transfusion rates, SFR, 30-day complications, ED visits, and readmissions were also comparable between the two groups. The mean operative (OR) time and incidence of Clavien-Dindo I complications were higher with t-PCNL with stent (80 minutes <i>vs</i> 58 minutes, <i>p</i> < 0.001,16% <i>vs</i> 3.8%, <i>p</i> = 0.048). Post-op pain scores and postanesthesia care unit stay times were similar. <b><i>Conclusions:</i></b> In this first ever comparison of outpatient t-PCNL to tt-PCNL, we found the same-day discharge of tt-PCNL patients to be safe and effective. Stent omission in our patients did not increase the risk of RF, ED visits, complications, or readmissions. A large, multicenter, randomized prospective controlled trial will help to confirm our findings.</p>","PeriodicalId":15723,"journal":{"name":"Journal of endourology","volume":" ","pages":"336-342"},"PeriodicalIF":2.9,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143584824","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Feasibility and Short-Term Safety of Hydrogel Spacer before Treatment with Magnetic Resonance Imaging-Guided Transurethral Ultrasound Ablation for Prostate Cancer Treatment.","authors":"Emily Bochner, Victoria Schulte, Yair Lotan, Xiaosong Meng, Daniel N Costa","doi":"10.1089/end.2024.0700","DOIUrl":"10.1089/end.2024.0700","url":null,"abstract":"<p><p><b><i>Purpose:</i></b> Magnetic resonance imaging (MRI)-guided transurethral ultrasound ablation (TULSA) is a minimally invasive method of ablating prostate cancer (PCa) using ultrasound energy under real-time temperature mapping provided by MRI. Posterior prostate tumors can be challenging to treat with adequate margins because of the proximity of the anterior rectal wall. We report our initial experience with rectal hydrogel spacer (spacer) placement in men undergoing TULSA for PCa treatment. <b><i>Materials and Methods:</i></b> A small cohort of men with spacers placed before TULSA were analyzed. Spacers were recommended in patients with posterior lesions near the rectal wall. Spacers were placed before TULSA with no other significant modifications during treatment day. Anatomical separation from the spacer was evaluated with <i>ad hoc</i> review of pre-/postspacer placement images. <b><i>Results:</i></b> Nine patients underwent TULSA with spacers in place, of which two patients had pre-existing spacers in preparation for radiation before switching to TULSA, and seven had intentional spacer placement because of posterior lesions. Spacers resulted in a median separation between the rectal wall and posterior prostate at the index lesion of 6 mm (interquartile range 3-8). All treatments were completed as planned with no additional artifact introduced because of the spacer. No postoperative complications were attributed to the presence of spacer during TULSA. <b><i>Conclusions:</i></b> We demonstrated that TULSA can be safely performed in patients with both polyethylene glycol-based and hyaluronic acid-based hydrogel rectal spacers. The presence of rectal spacer does not appear to impact thermoablation of targeted lesions and enables wider margins during posterior ablations.</p>","PeriodicalId":15723,"journal":{"name":"Journal of endourology","volume":" ","pages":"418-425"},"PeriodicalIF":2.9,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143382619","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Economic Burden of Imaging and Interventions in Endourology: A Worldwide Cost Analysis from European Association of Urology Young Academic Urology Endourology and Urolithiasis Working Party.","authors":"Amelia Pietropaolo, Etienne Xavier Keller, Tarik Emre Sener, B M Zeeshan Hamed, Arman Tsaturyan, Eugenio Ventimiglia, Patrick Juliebø-Jones, Christian Beisland, Ioannis Mikoniatis, Lazaros Tzelves, Vincent De Coninck, Frederic Panthier, Michael Chaloupka, Ewa Bres-Niewada, Alba Sierra Del Rio, Laurian Dragos, Nariman Gadzhiev, Anil Shrestha, Azimdjon Tursunkulov, Khurshid R Ghani, Chinnakhet Ketsuwan, Alexandre Danilovic, Felipe Pauchard, Hatem Kamkoum, Johan Cabrera, Mariela Corrales, Yazeed Barghouthy, Jia-Lun Kwok, Theodoros Tokas, Catalina Solano, Pablo Nicolas Contreras, Saeed Bin Hamri, Naeem Bhojani, A Carolien Bouma-Houwert, Thomas Tailly, Otas Durutovic, Bhaskar K Somani","doi":"10.1089/end.2024.0673","DOIUrl":"10.1089/end.2024.0673","url":null,"abstract":"<p><p><b><i>Background and Objective:</i></b> The cost of imaging and interventions in the surgical field varies between countries and sometimes within different regions of the same country. Procedural cost takes into account equipment, consumables, operating room, surgical, anesthetic and nursing teams, radiology, medications, and hospital stay. Health care systems therefore face an incredible burden related to investigations and surgical procedures. The aim of this study was to collect costs of imaging and interventions for kidney calculi across different hospitals and health care systems in the world. <b><i>Methods:</i></b> An online shared Google spreadsheet was created by the European Association of Urology Young Academic Urology urolithiasis group. The survey consisted of the cost of four radiological imaging (ultrasound of the urinary tract [USS], plain X-ray radiography of the abdomen including kidneys, ureter, and bladder [XRKUB], noncontrast-enhanced computerized tomography [CTKUB], and contrast-enhanced CT with urographic phase [CTU]) and seven interventions (endoscopic laser treatment of renal stones, ureteroscopic treatment or extraction of ureteral stones, percutaneous nephrolithotomy (PCNL), insertion of ureteral stent, diagnostic ureteroscopy, and cystolitholapaxy). A chosen representative from each country collected and collated the data, and this was converted to Euros (€). <b><i>Key Findings and Limitations:</i></b> Data were collected from 32 countries, which include Turkey, Armenia, Nepal, Uzbekistan, Brazil, Chile, Qatar, Peru, Israel, Singapore, Thailand, Colombia, Argentina, Saudi Arabia, Asia, North America, 15 countries from the European continent, and the United States. The mean cost of USS, XRKUB, CTKUB, and CTU was 51.3 € (range: 2-160 €), 27.1 € (range: 2.5-187 €), 105.8 € (range: 19-405 €), and 171.5 € (range: 19-674 €), respectively. Similarly, the cost of endoscopic laser treatment of renal stones, ureteroscopic treatment/extraction of ureteral stones, PCNL, insertion of ureteral stent, diagnostic ureteroscopy, and cystolitholapaxy was 1942.6 € (range: 100-7887 €), 1626.8 € (range: 80-9787 €), 2884.6 € (range: 110-12642 €), 631 € (range: 110-2787 €), 861.6 € (range: 3-2667 €), and 876 € (range: 19-3457 €), respectively. Wide differences in cost between countries were found within the study. <b><i>Conclusions and Clinical Implications:</i></b> This study highlights the significant economic impact of kidney stone management on health care systems worldwide. There seem to be significant disparities between costs, and this study shows the social and economic inequalities in health care access, which can differ significantly between private and public health care. These results can aid policymakers to address these disparities and perhaps to learn from other health care providers.</p>","PeriodicalId":15723,"journal":{"name":"Journal of endourology","volume":" ","pages":"389-398"},"PeriodicalIF":2.9,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143527821","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}